腹腔镜下垂直切割闭合直肠远端在直肠低位双吻合中的作用和意义

陈少骥; 吴云云; 韩善亮; 莫秦良; 马远明; 赵宏

doi:10.3969/j.issn.1007-3969.2014.11.006

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腹腔镜下垂直切割闭合直肠远端在直肠低位双吻合中的作用和意义

更新时间：2025-12-31

- 腹腔镜下垂直切割闭合直肠远端在直肠低位双吻合中的作用和意义
- The significance and role of laparoscopic vertical cutting of the closed distal rectum in dualanastomosis for patients with low rectal cancer
- 中国癌症杂志 2014年24卷第11期页码：830-835
- 作者机构：
  
  1. 苏州大学附属第一医院普外科,江苏,苏州,215000
  2. 苏州市吴江区第一人民医院外科,江苏,苏州,215000
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2014.11.006
  中图分类号：
- 网络出版：2015-05-05，
  
  纸质出版：2014-05-05
- 稿件说明：
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陈少骥,吴云云,韩善亮,莫秦良,马远明,赵宏. 腹腔镜下垂直切割闭合直肠远端在直肠低位双吻合中的作用和意义[J]. 中国癌症杂志, 2014, 24(11): 830-835.

陈少骥, 吴云云, 韩善亮, et al. The significance and role of laparoscopic vertical cutting of the closed distal rectum in dualanastomosis for patients with low rectal cancer[J]. China Oncology, 2014, 24(11): 830-835.
陈少骥,吴云云,韩善亮,莫秦良,马远明,赵宏. 腹腔镜下垂直切割闭合直肠远端在直肠低位双吻合中的作用和意义[J]. 中国癌症杂志, 2014, 24(11): 830-835. DOI： 10.3969/j.issn.1007-3969.2014.11.006.

陈少骥, 吴云云, 韩善亮, et al. The significance and role of laparoscopic vertical cutting of the closed distal rectum in dualanastomosis for patients with low rectal cancer[J]. China Oncology, 2014, 24(11): 830-835. DOI： 10.3969/j.issn.1007-3969.2014.11.006.

摘要

背景与目的：中低位直肠癌根治术中行直肠低位双吻合，术后易发生吻合口瘘及“直肠低位前切除术后综合征”等并发症，如何降低这些并发症的发生，目前临床仍处于探索之中。本研究的目的是观察、探讨腹腔镜下垂直切割闭合直肠远端在改进直肠低位双吻合中的作用和意义。方法：将2010年2月—2014年6月在苏州大学附属第一医院普外科完成腹腔镜下直肠癌根治术的120例中低位直肠癌患者，随机分为A、B两组。以性别、年龄、肿瘤大小、下缘离齿状线距离及肿瘤分期等为指标，逐一配对。其中A组(观察组)55例，在进行“第一吻合”时，将常规的直肠远端切割闭合，由水平方向改为垂直方向；行“第二吻合”时，行肠-肠“端-角”吻合，去除直肠远侧闭合线上端角部(“狗耳”)；血管夹夹闭去除下端“狗耳”；加强缝合“端-角”吻合后形成的一处钉合线“T”形交汇处(“危险三角”)。B组(对照组)65例，按直肠低位双吻合常规操作完成手术，两只“狗耳”及两处“危险三角”不作任何处理。将两组患者进行对比分析。结果：A组在垂直切割闭合直肠远端后，“狗耳”及“危险三角”均位于同一垂直线上，便于观察和处理。“端-角”吻合后远近端肠管轴线形成一定交角，远端直肠腔形成类似“壶腹”样膨隆；无“狗耳”存在，一处“危险三角”得以缝合加强。B组完成“端-端”吻合后远近端肠管在同一轴线上，留有两只“狗耳”及两处“危险三角”。两组患者的一般临床资料差异无统计学意义(P0.05)。两组患者术中出血量、术后引流量、术后吻合口出血、肛门排气时间和住院时间差异无统计学意义(P0.05)。手术耗时、术后吻合口瘘的发生数、排便次数、里急后重、术后再次手术造瘘差异有统计学意义(P0.05)。结论：直肠低位双吻合时垂直切割闭合远侧直肠，使双吻合后肠管的走行和形态更接近直肠的生理弯曲和形态；同时方便了术中去除“狗耳”和“危险三角”的加强缝合；术后并发症发生率显著降低。

Abstract

Background and purpose: Anastomotic leakage and low anterior resection syndrome(LARS) are both common complications in dual-anastomosis for patients with low rectal cancer. The aim of this study was to observe and explore the significance and role of vertical cutting of the closed distal rectum in dual-anastomosis for patients with low rectal cancer. Methods: A total number of 120 patients with mid-low rectal cancer who admitted to and completed laparoscopic rectal cancer resection in the Department of General Surgery

the First Affiliated Hospital of Soochow University from Feb. 2010 to Jun. 2014 were pair-matched into Groups A and B based on their gender

age

tumor size

the distance of lower edge to the dentate line and tumor staging

etc. For the 55 patients in Group A (observation group)

the rectum distal end was closed vertically instead of horizontally while disposing “the first intestinal anastomosis”

intestine-intestine anastomosis was conducted in an “end-corner” approach when dealing with “the second intestinal anastomosis”

upper corner (“dog ear”) of the closed line in the distal end of the rectum was removed

the lower corner (“dog ear”) of the closed line in the distal end of the rectum was removed using vascular occlusion clamp method

and the T-shaped interchanges (“dangerous triangle”) of stapled sutures formed after anastomosis were strengthened with absorbable suture. For the 65 patients in Group B (control group)

laparoscopic dual anastomosis was conducted using conventional method

and the two “dog-ears” and “dangerous triangles” were kept without any treatment. The clinical outcomes of the two groups of patients were analyzed retrospectively.Results: In group A

It was convenient to complete the operation when the “dog ears” and “dangerous triangle” on the vertical line after cutting the closed distal rectum vertically by “end-corner” anastomosis. The axis of intestine formed a certain angle making the closed distal rectum into “ampulla” sample without “dog ears”. the “dangerous triangle” were strengthened with absorbable suture. In group B

The distal and proximal intestine located on the same axis after intestine-intestine anastomosis leaving two “dog ears” and a “dangerous triangle”. The general clinical data of patients in the two groups were comparable and not significantly different (P0.05). The two groups of patients showed no significant differences in blood loss

postoperative drainage

postoperative anastomotic bleeding

anal exhaust time

and length of hospital stay (P0.05). However

the operation time as well as the numbers of anastomotic fistula occurrence

defecation

tenesmus and post-operation re-ostomy differed significantly (P0.05). Conclusion: Vertical cutting of the closed distal rectum with dual anastomosis made the “new” intestine closer to the physiological bending and morphology of the rectum

meanwhile

it simplified the approach of removing “dog ear” and strengthening “dangerous triangle”

finally it significantly reduced the incidence of post-surgical complications.

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